2013-14 SANITARY SEWER AND MANHOLE REHABILITATION - 14-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (5)VACVENV -01 JFAVA
'` �REP CERTIFICATE OF LIABILITY INSURANCE
` °°
21f1 101 0120115 5
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the
certificate holder In lieu of such endorsemen s .
PROADCER
ASSOCIATES AGENCY, INC.
11470 N 63rd St
CONTACT
NAME:
PHONE PAX
813 988 -9234 , way' (013) 988 -4989
Temple Terrace, FL 33617
ADURESS,
INSURE S AFFOROIHGCOVERAGE HAICN
% 300,00
INSURSKA:Southern CWners Insurance Co '10190
............
INSURED
INSURER a. OWNERS INSURANCE CO. 332700
INSuRERc,AUTO OWNERS INSURANCE CO. .18988
Vacvlsfon Environmental, LLC
IN%VRER D;Rockhili Insurance Co
10200 E US Hwy 82
Tampa, FL 33610
RiSiJRER E
INSURER F : j
• E 3,000,
COVERAGES CERTIFICATE NUMBER: Rr-vLCInN kill uaru•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSNRAHCE
POLICY KWSER
M LIMrrs
A X I CgMMI =RML OIEHERAL LiASH -ITV
EACH OCCURRENCE
S 1,000,
+ CLAIMS MADE occur; 20710123
07/1012014 07r1ti12015 PREmSES Ea wourrence
% 300,00
S 10,0
s
! MED EXP one pen m)
1 s 1,f]on,nnD
PERSONAL & ADV INJURY
S 3,00n,R
• GENL AGGREGATE LIMIT APPLIES PER.
-
I GENERAL AGGREGATE
? POLICY JECT LOC
I PRODUCTS - COMP+OP AGG
• E 3,000,
f
OTHER:I
AUTOMOOK@LIABILITY 4
LE GMIT
ar
B ](� ANY Aura ! 4770262602
07/10/2014
071/0/2015 BODILY INJURY (Per pareaN 1$
H LED UTOS UF i
i
BODILY INJURY (Per accident) • S
. x ! HIRED AUTOS x � ALY70S�ED
Paam�� I S
X i UM9RELLA 41A11 x i OCCUR i
EACH O=RRENCE E 5,000r
ExD1 ss IJAS CLAIMS-IAAt)E 4770262601
0711012014
07M 012075 . AGOREGATE s 6,000,
X t 610001
DED RETENTION S
y
WORKER$ COMPENSATION
I X ' 7A7liT£
AND EMPLOYERS' LIABILITY Y 7 H I
ER
C
R ARR : 70162723
0711012D14
0711012015 E E L EACH ACCIDENT :3 1,000,
OFFICE�Rl EXCLUDE N r A
�`-
(Mandam y Iry NHI
I
: E.L DISEASE . EA EMPLOYEE $ 1.0ff0,
esdlbe ur>dfu
WIPT7DN OF OPERATIONS below I
E.L DISEASE - POLICY LIMIT S 1,000,
D
Pollution Policy
!
ENVPOO"27.02
0811012014
08/7012015 OCGAGG 2,000,
DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORA 161, AdcNonal Rermrks Schedule, may b4 afikOW If mbra space reRuked)
PROJECT NAME: 2017 -14 SANITARY SEWER AND MANHOLE REHABILITATION PROJECT #14-0025 -i3i�
The City of Clearwater and anyone when required by Contract. are additional insureds with regard to the 9e era! liability . A waiver of subrogation applies tot
h general liability and workers compensation policies in favor of the additional insureds when required try contract.
CERTIFICATE HOLDER CANCELLATION
®1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014)01) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THIS ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwa tar
THE EXPIRATION DATE THEREOF, NOTICE WILL 6E DELIVERED IN
Engineering Department
ACCORDANCE WITH THE POLICY PROVIS*NS.
100 S. Myrtle Avenue
AUTHORIZED REPRESENTATIVE
Clearwater, FL 33756
7:�w
®1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014)01) The ACORD name and logo are registered marks of ACORD